Cervical spine motion during airway management: A cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers

We conducted a randomized, controlled, crossover study to determine cervical spine motion for six airway management techniques in human cadavers with a posteriorly destabilized third cervical (C-3) vertebra. A destabilized C-3 segment was created in 10 cadavers (6-24 h postmortem). Cervical motion was recorded by continuous lateral fluoroscopy. The following airway management techniques were performed in random order on each cadaver with manual in-line stabilization applied: face mask ventilation (FM), laryngoscope-guided orotracheal intubation (OETT), fiberscope-guided nasal intubation (FOS-NETT), esophageal tracheal Combitube® (Kendall-Sheridan, Neustadt, Germany) insertion (ETC), intubating laryngeal mask insertion with fiberscope-guided tracheal intubation (ILM-OETT), and laryngeal mask airway insertion (LMA). Afterward, maximum head-neck flexion (FLEX-MAX) and maximum head-neck extension (EXT-MAX) without manual in-line stabilization was performed to determine maximum motion. The maximum posterior displacement of C-3 and the maximum segmental sagittal motion of C2-3 were determined. There was a significant increase in posterior displacement for the FM (1.9 ± 1.2 mm, P < 0.01), OETT (2.6 ± 1.6 mm, P < 0.0001), ETC (3.2 ± 1.6 mm, P < 0.0001), ILM-OETT (1.7 ± 1.3 mm, P < 0.01), LMA (1.7 ± 1.3 mm, P < 0.01), FLEX-MAX (3.7 ± 1.9 mm, P < 0.0001), EXT-MAX (1.8 ± 1.7, P < 0.01), however, not for FOS-NETT (0.1 ± 0.7 mm). Posterior displacement was less for the ILM-OETT and LMA than for the ETC (both P < 0.04). There were no significant increases in segmental sagittal motion with any airway manipulation other than with FLEX-MAX (-4.5 ± 4.0°, P < 0.01). Posterior displacement was similar to FLEX-MAX for the OETT and ETC; however, it was less for the FM, FOS-NETT, ILM-OETT, and LMA (all P < 0.01). Posterior displacement was similar to EXT-MAX for all airway manipulations other than for FOS-NETT (P < 0.001). For cervical motion and the techniques tested, the safest method of airway management in a patient with a posteriorly destabilized C-3 segment is FOS-NETT. LMA devices may be preferable to the ETC

A new guidance device facilitates percutaneous puncture of the foramen ovale in human cadavers

Trigeminal neuralgia is the most common neurological cause for facial pain. Contemporary interventional treatment relies on surgical microvascular decompression or, alternatively, percutaneous interventions targeting the semilunar ganglion via the foramen ovale. For the latter approach, only free-hand punctures using fluoroscopy devices have been reported. Therefore, the present study aimed to evaluate a new fluoroscopy-based guidance device for transforaminal puncture. Two experienced examiners punctured the foramen ovale bilaterally free-hand, and using a guidance device in human cadavers (n = 9). The number of attempts for puncture was recorded. A new attempt was counted each time the needle had to be retracted for redirection. As compared to the free-hand puncture of the foramen ovale (4.44 +/- 2.79), the new guidance device significantly reduced the number of trials needed (1.37 +/- 0.69). The employment of a guidance device facilitated percutaneous transforaminal puncture and resulted in a significantly decreased number of puncture attempts as compared to free-hand techniques in human cadaver